Arsenic Poisoning

1. Arsenic Poisoning
By:
Heba Numan Harara
Jamila Temraz
Submitted to:
Prof.Dr. Jamal safi
2014

2. Objectives
What is Arsenic?
Arsenic Characteristics
Circumstances Of Poisoning
Natural Arsenic Level
Sources of Arsenic
Toxic kinetics
How might I be exposed to As ?
Adverse Health Effects
Treatment and management
Case study
Conclusions
References

3. Elemental arsenic is a naturally-occurring
silver-gray solid metalloid. The element (zero
valence) form, which rarely exists in nature and
has low solubility, is seldom a cause of human
toxicity. (Kosnett MJ et al.2005)
Inorganic As is a human carcinogen (EPA,
1984)
What is Arsenic?

4. Arsenic Characteristics
• It is cheap
• Easily obtained
• Colourless
• No smell
• No taste
• Small quantity is required to cause death.
• Can be easily administered with food or drink.
• Onset of symptoms is gradual
• Symptoms simulate those of Cholera.
Arsenic is the most popular Homicidal poison

5. Arsenic Characteristics
• Most natural waters contain inorganic species
– As (III) or arsenite predominant in ground waters
H3AsO3
– As (V) or arsenate in surface waters H2AsO4 &
HAsO4
-2
Levels of As in water depend on:
Distance from pollution sources
Level of human activity

6. Circumstances Of Poisoning
Disadvantages Of Arsenic:
• It delays putrefaction
• Can be detected in completely decomposed
bodies.
• Can be found in bones, hairs and nails for
several years.
• Can be detected in charred bones or ashes.
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7. Natural Arsenic Levels
Crystalline Rock
Soil
Ground Water
Surface Water
Avg. 2 ppm
1-40 ppm
0.01 – 800 ppb
As high as 40,000 in hot springs
2.38 – 65 ppb
As high as 22,000 in river water

8. Sources of Arsenic
Natural
•As occurs naturally & is widely distributed in
the Earth’s crust .
•Volcanic activity, rock & mineral erosion, &
forest fires release As
•As is often concentrated in sulfide-bearing
mineral deposits (e.g., gold and copper)

9. Anthropogenic Sources and uses
•Smelting of metals
•Pharmaceutical industry
(medicines)
•Pesticide manufacture (very
limited)
•Wood preservative – CCA [in
phase out]
•Cattle and sheep dips
•Feed additives
•Dye stuffs
•Petroleum, coal, and wood
burning
•Semiconductor manufacture
•Waste incineration
•Drilling Wells
•Mineral Extraction
•Processing Wastes

11. Toxicokinetics of arsenic in the body
• Absorption
–Soluble forms
• Humans – 40 % to complete absorption
• Animals – 50% to complete absorption
–Insoluble forms
• Limited absorption

12. Toxicokinetics cont.
• Distribution
–Found in all humans – Blood conc. (1-5 ppb)
• Smokers (2 – 10 ppb)
• Occupational exposure (10 ppb)

13. Distribution
Bound to red blood cells and globulin
 Re –distribution (24 hours): liver, lungs, spleen
 Binds to sulfhydryl-containing proteins
 Long term distribution and high concentration in bone
and keratinized tissues
 Hair and fingernails (Mees’ lines)
• Highest levels (ppb)
– Nails (0.89)
– Hair (0.18)
– Bone (0.07 – 0.12)
– Heart, kidney, liver, lung (0.03 – 0.05)

14. Excretion
• Primarily via urine
– 60% - 95% in 5 days
• Fecal excretion low
•Arsenic is excreted mainly by the kidneys. Renal
tubules can convert As5+ (Arsenate) to the more
toxic As3+ (Arsenite).
•Prenatal exposure to arsenic, through placental
transfer, can cause marked damage to the Fetus.
•Crosses placenta, may cause stillbirth

17. CHEMICAL COMPOSITION AND TOXICITY:
ARSINE GAS (AsH3) THE MOST TOXIC
Inorganic arsenic
Trivalent (As3+)
 Arsenic trioxide
 Soluble
 More toxic
 Pentavalent (As5+)
 Arsenic pentoxide
 e.g. Lead arsenate
 Lower solubility
 Less toxic
Organic arsenic
 Less soluble
 Less toxic
 Produced by
biomethylation
 Detoxified in humans
- High source
The toxicity of arsenic depends on its chemical composition
and valency, arsine gas being the most toxic form.

18. Inorganic Forms of As
• Inorganic arsenic compounds are used
to preserve wood.
• In the environment, As combines with
oxygen, chlorine, & sulfur to form
inorganic compounds.
• Inorganic forms are toxic.

19. Organic Forms of As
• As in animals and plants combines
with carbon and hydrogen to form
organic arsenic compounds.
• Organic arsenic compounds are used
as pesticides, primarily on cotton
plants.
• Fish & shellfish can accumulate
organic forms (nontoxic).

20. As in the Environment
• As can only change its form in the
environment. It cannot be destroyed.
• As in air will settle to the ground or is washed
out of the air by rain.
• Many As compounds are easily solubilized in
water due to changes in pH and temperature

21. How might I be exposed to As ?
• Eating food, drinking water, or breathing air
containing As
• Breathing sawdust or burning smoke from
wood treated with As
• Living near uncontrolled hazardous waste
sites containing As
• Living in areas with unusually high levels of
As in rock

22. ARSINE GAS
 The most toxic, a potent hemolytic agent
Colorless
 Non-irritant
 Evolves from arsenic compounds by addition of acid
 Immediate death occurs at 150 ppm, or in 30
minutes from 25-50 ppm
Hemolysis from arsine inhalation may result in intra-
renal deposition of hemoglobin and debris of lysed
erythrocytes leading to renal tubular damage and
renal failure, as well as hypoxia.

23. Poisonous Compounds of Arsenic
Arsenic oxide or Arsenic Trioxide
It is the most common form of arsenic used.
It is also known as White Arsenic.
No taste or smell and is sparingly soluble in water.
It is heavier than water by three and half times but
freely floats on water.
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26. Adverse Health Effects
• Non-Cancer

27. Acute Toxicity
lAnima
Rats
Mice
Guinea pigs
Humans
mg/kg)(50LD
15 - 293
26 - 43
9
1 - 4 (approx)

28. Acute Effects – Humans
(est. LD50  1-4 mg/kg)
• Peripheral neuropathy
• Anemia
• Renal and liver dysfunction
• Skin pigmentation
• EKG abnormalities
• Severe GI effects

29. Chronic Toxicity: Humans Vascular
• Poland
–Vintners
–6 cases of gangrene

30. Chronic Toxicity: Humans
• Nervous system
–Peripheral neuropathy – legs and
arms
• Cranial nerves
–Loss of hearing in Japanese infants

31. Adverse Health Effects
• Cancer

32. Cancers Associated with Exposure to
Arsenic in Drinking Water
Cancer: Long-term Exposure (20-40 yrs)
Skin cancer (Taiwan)
Keratosis and Hyperpigmentation
•Blackfoot Disease (Mainly Taiwan)
•Lung cancer (Taiwan, Japan, & Chile)

33. •Bladder cancer (Taiwan, Argentina)
In a study conducted in the United States no reports of bladder
cancer with average 40 µg of As/L in a study.
•In a case control study in conducted in Western United States,
it was found that smoking can elevate bladder cancer risk when
drinking water has As levels near 200 µg/day

34. What Are the Symptoms of Arsenic Poisoning?
Short-term (acute) arsenic poisoning can cause:
Nausea
Vomiting
Diarrhea
Cough
Headache
Weakness
Loss of appetite
Shaking

35. Long-term (chronic) poisoning symptoms in human
beings due to arsenic are:
Skin pigmentation
Numbness
Diabetes
Vascular disease
Cardiovascular disease

36. Protection from Arsenic ?
• An inverse correlation was found between
consumption of vitamins A, C, and E, riboflavin
and folic acid, and the existence of dermatological
manifestations or chronic arsenic exposure.
• The population was
recently surveyed and
those individuals who had
diets deficient in certain B
vitamins and antioxidants
appeared to have greater
risk of arsenic dermatoses.
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37. Treatment and management
Airway
Breathing
Circulation
Pre-Hospital care
Emergency Department
•. Hemodynamic stabilization.
• Orogastric lavage – for acute arsenic poisoning
• Whole bowel irrigation with polyethylene glycol may be
effective to prevent GI tract absorption of arsenic
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38. Treatment and management
• Dimercaprol (BAL in Oil): First-line agent for
treating arsenic poisoning. May be
administered to patients with renal failure.
• Succimer (DSMA): used only in childhood
lead poisoning.
• Dimerval (DMPS): accepted DOC for
treating most heavy metal poisonings.
Chelation Agents
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39. Treatment and management
• Hemodialysis is
especially useful in a
patient with arsenic
poisoning with renal
failure or with
impending renal
failure.
Hemodialysis&exchange transfusion
39

42. Arsenic exposure in Latin America: Biomarkers, risk assessments
and related health effects, (Tyler R. McClintock a, Yu Chen,2012)
• In Latin America, several regions have a long history of
widespread arsenic (As) contamination from both
natural and anthropological sources. Yet, relatively little
is known about the extent of As exposure from drinking
water and its related health consequences in these
countries.
• It has been estimated that at least 4.5 million people in
Latin America are chronically exposed to high levels of As
(N50 μg/L), some to as high as 2000 μg/L — 200 times
higher than the World Health Organization (WHO)
provisional standard for drinking water.

43. Despite some methodological limitations, these
studies suggested important links between the
high levels of chronic As exposure and elevated
risks of numerous adverse health outcomes in
Latin America — including internal and external
cancers, reproductive outcomes, and childhood
cognitive function.

44. • An earlier study captured bladder cancer mortality in
approximately 2,750,000 inhabitants living in 26
counties of Córdoba province in Argentina between
1986 and 1991.
• The study found strong association between As
exposure and deaths from bladder cancer mortality.
• The finding demonstrated that mortality started to
increase after 10 years of high exposure in Chile's
Region II in 1958 and continue to rise even after 25
years of reducing the exposure to a low level (Marshall
et al., 2007).

45. • In Nicaragua, high levels of As have been identified in
ground water (up to 1320 μg/L) in El Zapote and
Llano La Tejera (Bundschuh et al., 2008).
• A survey in 2005 found 87% of the 54 wells had
higher As more than 10 μg/L (Cuevas and Bundschuh,
2010).
• Very high levels of As have been detected in the soil
(50–1000 mg/kg) from the Iron Quadrangle area of
the southeastern part of Brazil, where gold and other
mining activities have been operating over 250 years
(Matschullat et al., 2007).

46. • Water from the mining districts Nova Lima and Santa
Barbara contain As as high as 350 μg/L (Matschullat
et al., 2007).
• High levels of As in drinking water Mexico were first
identified in 1958.
• Study in the region of Lagunera found 64% of the
wells to have As concentrations higher than 50 μg/L,
with a range of 8–624 μg/L (Del Razo et al., 1993).
• Ground water in the Zimapan and Guanajuato areas
contained As between 190 and 650 μg/L (average
380 μg/L) and 280 μg/L (Armienta and Segovia,
2008).

47. • Latin America has, though, been the focus of important studies
that have contributed significantly to current knowledge of As
effects on human health — specifically with respect to the
development of bladder, lung, and skin cancer. While
development of and deaths from cancer may take as long 35
years after exposure.
• Deaths from cardiovascular or respiratory diseases in children
seem to occur during or soon after a period of high exposure —
making shorter-term consequences of exposure a vital area of
research (Rosenberg, 1974; Yuan et al., 2007; Zaldivar, 1980).
• As a result, studies have observed elevated fetal mortality,
neonatal mortality, post neonatal mortality, reduced birth
weight, and anemia in the mother (Hopenhayn-Rich et al., 2000;
Hopenhayn et al., 2006; Hopenhayn et al., 2003a)

48. • Smoking was also found to influence risk of bladder
cancer due to As, with individuals excreting high to have
a quadrupled OR if they were also smokers (Steinmaus et
al., 2006).
• With respect to lung cancer, synergistic effects was
observed among smokers exposed to water As more
than 200 μg/L compared to nonsmokers exposed to less
than 50 μg/L (Ferreccio et al., 2000).

49. • Such short-term effects such as low birth weight and
impaired cognitive development have also been
observed. As-induced DNA damage in children may
explain the under lying mechanisms of cancer risk at
later life and future health risk.
• With studies indicating that As can account for 7– 20%
of all deaths among exposed populations (Argos et al.,
2010; Smith et al., 1998)

50. Arsenic exposure and adverse health effects: A review of recent
findings from arsenic and health studies in Matlab,
Bangladesh(2011)
• The recent discovery of large-scale arsenic (As)
contamination of groundwater has raised much concern
in Bangladesh.
• Reviews of findings to date suggest the adverse effects
of As exposure on the risk of skin lesions, high blood
pressure, diabetes mellitus, chronic disease, and all-
cause infant and adult disease mortality.

51. Arsenic exposure and adverse health effects: A review of recent findings
from arsenic and health studies in Matlab, Bangladesh(2011)

52. [6] Rahman M, Vahter M, Wahed MA, Sohel N, Yunus M, Streatfield PK, et al. Prevalence of
arsenic exposure and skin lesions. A population based survey in Matlab, Bangladesh.
J Epidemiol Community Health 2006;60(3):242e8.
[7] Rahman M, Vahter M, Sohel N, Yunus M, Wahed MA, Streatfield PK, et al. Arsenic exposure
and age and sex specific risk for skin lesions: a population-based case-referent study in
Bangladesh. Environ Health Perspect 2006;114:1847e52.
[16] Rahman A, Vahter M, Ekstrom EC, Rahman M, Golam Mustafa AH, Wahed MA, et al.
Association of arsenic exposure during pregnancy with fetal loss and infant death: a cohort
study in Bangladesh. Am J Epidemiol 2007;165:1389e96.
[17] Hore SK, Rahman M, Yunus M, Das CS, Yeasmin S, Ahmad SK, et al. Detecting arsenic-
related skin lesions: experiences from a large community-based survey in Bangladesh. Int J
Environ Health Res 2007;17:141e9.
[19] Sohel N, Persson LA, Rahman M, Streatfield PK, Yunus M, Ekstrom EC, et al. Arsenic in
drinking water and adult mortality: a population-based cohort study in rural Bangladesh.
Epidemiology 2009;20:824e30.
[20] Lindberg AL, Ekstrom EC, Nermell B, Rahman M, Lonnerdal B, Persson LA, et al. Gender
and age differences in the metabolism of inorganic arsenic in a highly exposed population in
Bangladesh. Environ Res 2008;106:110e20.
[22] Jakariya M, Vahter M, Rahman M, Wahed MA, Hore SK, Bhattacharya P, et al. Screening of
arsenic in tubewell water with field test kits: evaluation of the method from public
health perspective. Sci Total Environ 2007;379:167e75.
[23] Lindberg AL, Rahman M, Persson LA, Vahter M. The risk of arsenic induced skin lesions in
Bangladeshi men and women is affected by arsenic metabolism and the age at first exposure.
Toxicol Appl Pharmacol 2008;230:9e16.

54. • As exposure causes significant increased risk for death in
cancers, cardiovascular, and infectious diseases-related
mortality.
• A clear dose-response relationship was observed. The
results demonstrate that As exposure through drinking
water has started to generate excess adult mortality
after a few decades of exposure.
• Considering 25 million people are exposed, the present
generation may suffer from an excess of 200,000-
300,000 As-related cancer cases.

55. CASE STY:US WATER ARSENIC MAP
The various colours indicate different concentrations of arsenic in water, with
red being the highest
Ref:
•U.S. Geological Survey (USGS) . Map of US – arsenic in water – Available at
http://co.water.usgs.gov/trace/arsenic/ - accessed 22 September 2011.

56. BANGLADESH WATER ARSENIC MAP
Image: Arsenic in West
Bengal & Bangladesh –
Arsenic Crisis Information
Center. Available
at http://bicn.com/acic –
accessed 22 September
2011.

57. Conclusions
•Public Health Can Be Severely Impacted by
presence of elevated levels of As in drinking
water
– ↑in mortality & morbidity
– Everyone is vulnerable
– Degrees of vulnerability depend on
Biological susceptibility
Exposure & dose
•There Are Safe Levels Below Which No Adverse
Health Effects Occur

58. •Reducing the arsenic MCL from 50 µg/L to 10 µg/L will
help reduce Arsenic exposure to approximately 13 million
Americans.
•The continued concern about the association between
inorganic arsenic and cancer has raised questions
regarding the implications of widespread dispersion of
inorganic arsenicals in the environment.
•The use of arsenical pesticides in food crops declined
greatly after introduction of the chlorinated hydrocarbon
and organophosphorus chemicals.

59. •Symptoms of arsenic poisoning: When arsenic
poisoning mouth there is a sense of astringent taste
followed after swallowing latency period symptoms
ranging from 15 minutes to not show them a few hours,
depending on the content of the stomach of food and
kind, it retards the presence of greasy food absorption
of arsenic for long periods while accelerates absorption
abuse arsenic in the image of a solution in a hot drink.
•And start poisoning symptoms in the form of severe
vomiting and severe diarrhea (cholera-like) give rise to
dry fast and collapse

60. References:
•http://users.physics.harvard.edu/~wilson/arsenic/arsenic_project_health_effects.hml
•http://www.mnn.com/health/fitness-well-being/stories/5-facts-about-arsenics-effects-
on-the-human-body
•Tyler R. McClintock a, Yu Chen b, Jochen Bundschuh c,d,e, John T. Oliver f, Julio Navoni g,
Valentina Olmos g, Edda Villaamil Lepori g, Habibul Ahsan h, i, Faruque Parvez, Arsenic
exposure in Latin America: Biomarkers, risk assessments and
related health effects, ٤۲۹)۲۰۱۲(۷٦–۹۱
•http://www.greenfacts.org
•Mohammad Yunus , Nazmul Sohel , Samar Kumar Hore , Mahfuzar Rahman ,
2011,Arsenic exposure and adverse health effects. 27, 371-376.
•Tyler R. McClintock, Yu Chen,2012. Arsenic exposure in Latin America: Biomarkers,
risk assessments and related health effects 429 (2012) 76–91
•Aiva L, Marcos R, Creus A, Coggan M, Oakley AJ, Board PG. Polymorphism of
glutathione transferase Omega 1 in a population exposed to a high environmental
arsenic burden. Pharmacogenet Genomics 2008;18:1-10.